In healthcare, the choices patients make can have immediate and direct consequences on their care. Nowhere is this more evident than in a patient’s choice of physician, where the outcome of choice is an involved and potentially long-lived relationship with a fiduciary. Though patients are often connected with new physicians via referrals, the landscape of medicine has begun to place a large emphasis on patient satisfaction, which is largely driven by individual preferences and circumstances.1,2

Generally, patients seek to obtain high-quality care at a minimal cost. However, they often lack sufficient information to do so, creating a challenging circumstance for many patients to make a rational decision with respect to their physician.2 Moreover, it has been shown that patients are more likely to base their choice on factors such as physician age or medical school rather than on strictly outcomes-based metrics like technical equality or appropriateness.3 As a result, a number of web-based, consumer-focused resources have emerged to make the process of choosing a physician simpler for patients.4 Though rating and ranking systems are hardly new, the internet has given rise to an unprecedented ecosystem of these services, many of which promise an objective means of comparing physicians. However, these internet-based rating and ranking systems have drawn scrutiny due to a lack of transparency in selection criteria as well as a failure to translate into actual value for consumers.5 In addition, the sheer volume of information contained on various rating and ranking sites, each with a different set of scoring criteria, may have made it more difficult for patients to make informed choices.

Despite this, nearly 60% of patients report that online reviews are important when choosing a physician.6 Likewise, it is becoming increasingly important for physicians to understand how rating and rank sites generate their lists. One such site, Expertscape.com, uses an algorithm to score and then list “experts” in 29,000 topics, based on authorship of publications indexed in the PubMed database. The algorithm considers factors such as an article’s recency, its publication type (e.g. review article), journal impact factor, and the author’s authorship position.

“If a patient is not part of the medical field, the options they have for identifying very narrow specialists are appallingly limited.”

This system of ranking is particularly useful for generating lists of specialists, even to the level of single disease states, says John Sotos, MD, the CEO of Expertscape. “If a patient is not part of the medical field, the options they have for identifying very narrow specialists are appallingly limited.” Dr Sotos, who is a transplantation cardiologist by training, argued that a tool for comparing and locating specialists is relevant to patients now more than ever since medicine itself has become more and more specialized in recent years. “You can never have board certifications for single diseases, but if a physician has a patient with a rare disease, they might need to find somebody who is equivalent to board certified in treating that one disease. In a loose sense, Expertscape can be a proxy for that.”

Expertscape also aims to solve the transparency issue faced by many other physician rating and ranking sites, being one of the few to make its methodology readily available to site visitors. Likewise, it aims to minimize the ability of physicians to boost their own rankings since scientific publications are an objective scoring metric. Dr Sotos argues that this approach is rigorous, logical and completely objective. “There are other methods of highlighting experts and physicians, and these methods could potentially be manipulated. The only way to manipulate our system is to publish more and better,” he says.  

Even so, there are still some limitations to the way Expertscape generates its lists – namely, the fact that not all physicians publish research. For more frequently encountered disease states like diabetes, the physician most suited to treat a given patient may not necessarily publish academic research frequently, if at all. Likewise, many nonphysician researchers may rank highly on Expertscape lists. Dr Sotos acknowledges this, adding that the site is not strictly intended for consumers. Instead, he envisions it as a platform for patients, hospital systems, researchers, journalists, or even referring physicians to precisely find specialists to whom they can send patients. “If you are a physician in practice and you have a case that is approaching the limits of what you can do in your practice, you normally refer that patient to a specialist. If this is the first time in your career you are seeing an unusual condition, you may not have a referral pattern or referral practice to go along with that condition,” says Dr Sotos. 

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Expertscape is just one of many physician rating and ranking sites. As an increasing number of such services emerge, it will be important for physicians to consider how patients are using them. As one investigator wrote, “companies offering physician rating services should accept the responsibility of helping their customers understand the limitations of consumer ratings when selecting physicians, given that stakes are higher than in other marketplace settings and since health care consumers are poorly positioned to evaluate some aspects of care.”

References

1. Victoor A, Delnoij DM, Friele R, Rademakers JJ. Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients. Health Expectations. 2014;19(3):667-678. doi: 10.1111/hex.12224

2. Victoor A, Delnoij DM, Friele RD, Rademakers JJ. Determinants of patient choice of healthcare providers: A scoping review. BMC Health Services Res. 2012;12(1). doi: 10.1186/1472-6963-12-272

3. Tsugawa Y, Blumenthal DM, Jha AK, Orav EJ, Jena AB. Association between physician US News & World Report medical school ranking and patient outcomes and costs of care: observational study. BMJ. 2018. doi: 10.1136/bmj.k3640

4. Yaraghi N, Wang W, Gao GG, Agarwal R. How online quality ratings influence patients’ choice of medical providers: Controlled experimental survey study. J Med Internet Res. 2018;20(3). doi: 10.2196/jmir.8986

5. Daskivich TJ, Houman J, Fuller G, Black JT, Kim HL, Spiegel B. Online physician ratings fail to predict actual performance on measures of quality, value, and peer review. J Am Med Inform Assoc. 2017;25(4):401-407. doi: 10.1093/jamia/ocx083

6. Lagu T, Metayer K, Moran M, et al. Website characteristics and physician reviews on commercial physician-rating websites. JAMA. 2017;317(7):766. doi: 10.1001/jama.2016.18553